Feb. 2, 2011 -- Children who grow up in New England and the Upper Midwest get better health care than children in other states, especially those who live in the South and Southwest. That's according to a new report card that ranks all the states based on their children's health care policies.

The new report card, issued by the Commonwealth Fund, ranks states based on access to and affordability of health care, prevention and treatment, the ability to live a healthy life, and health system equity. It comes two years after the federal government reauthorized and expanded the Children's Health Insurance Program (CHIP), and these efforts may have helped to offset some of the negative effects of the recession on children's health care, authors of the report said during a telephone news briefing.

But "where children live matters, and it shouldn't," says Cathy Schoen, a senior vice president for policy, research, and evaluation at the Commonwealth Fund, a health care research group based in Washington, D.C.

Top 5 States for Healthy Kids

According to the new report card, the top five states for children's health care are:

Iowa

Massachusetts

Vermont

Maine

New Hampshire

The five states that fared the worst are:

Florida

Texas

Arizona

Mississippi

Nevada

Children in the top-performing states are far more likely to be insured and to receive the recommended medical and dental screening tests.

In 2009, 3% of children were uninsured in Massachusetts, compared to 17% to 18% in Nevada, Florida, and Texas, the new report shows.

"There are wide gaps between leading and lagging states for oral health problems, obesity, and smoking rates," says Karen Davis, president of the Commonwealth Fund.

If the lagging states caught up, 5.6 million more children would have insurance and 10.2 million more children would receive preventive care (including 600,000 more kids who would be up to date with all their childhood vaccines).

As to what separates the leaders from the laggers, Davis says that states that fared well tend to look at the big picture, she says. "They are focused on getting people into the care system, but also on having the care system think about healthy children, not just those at the hospital door," she says.

In general, the states that ranked at the top scored high on multiple indicators, she says. They tended to take proactive steps to cover children or families and promote public health.

By contrast, states that did not receive top marks tended to have less coherent public policies and were less transparent, meaning they were less likely to gather and share information on how one community compares to another in terms of health care initiatives.

"We can do better," says Edward Schor, MD, vice president of the Commonwealth Fund. "What is unique about this scorecard is that it looks at what has been achieved by the top states and holds that performance up as an example for other states. If it's possible to insure almost all kids in Alabama, it should be possible in Texas and Mississippi."

Alabama stood out among other Southern states for its high rates of insured children, the report showed.

CHIP: Another Viewpoint

Not everyone agrees with some of the report card's conclusions.

"This is very far from an even-handed look at the state of child health and it is being used this to drive a policy agenda," says Michael Cannon, director of health policy studies at the Cato Institute, a nonprofit libertarian think tank based in Washington, D.C.

It is not the state rankings that he takes issue with, but the fact that the group is using them to make a case for CHIP and other federal government health care policies, he says. "CHIP is cost-inefficient because it crowds out private insurance and makes people depend on government coverage," he says. In addition, "CHIP subsidies disappear when you increase your earnings, so many people fall into a low-wage trap."